NJSC and National Disability Insurance Agency

This matter concerned an application for review of a decision made by the National Disability Insurance Agency (NDIA) regarding supports for a young child with severe and complex Autism Spectrum Disorder. The child, aged three-and-a-half, exhibited dangerous and unsafe behaviours, and had older siblings also diagnosed with severe Autism Spectrum Disorder. The applicant, Ms NJSC, sought to challenge the NDIA's assessment of what constituted reasonable and necessary supports for her child. The case was heard by P Smith M.

The primary legal issue before the Tribunal was to determine whether the requested supports were "reasonable and necessary" within the meaning of section 34 of the National Disability Insurance Scheme Act 2013 (Cth). This required consideration of whether the supports represented value for money, were effective and beneficial, and were most appropriately funded or provided through the NDIS rather than other systems. The Tribunal also had to consider whether there was sufficient evidence to make an assessment of reasonable and necessary supports.

The Tribunal's reasoning involved an examination of the provisions of the NDIS Act concerning the development and approval of participant plans, specifically the statement of participant supports. It referred to section 33 of the Act, which outlines the requirements for such statements, including the need to consider the participant's goals and aspirations, the reasonableness and necessity of supports under section 34, the conduct of relevant assessments, and the effectiveness of previous plans. The Tribunal considered the evidence presented by Ms NJSC regarding her employment, her husband's employment, and the family's living situation, including temporary accommodation due to flood damage. However, the Tribunal ultimately found that the evidence did not support the requested supports being deemed reasonable and necessary under the NDIS Act.

The Tribunal affirmed the decision under review.